Democratic presidential candidates Hillary Clinton and Bernie Sanders sparred over health care policy during a debate in Charleston, S.C., on Jan. 17. At one point, Sanders rejected assertions by Clinton that a Sanders presidency could imperil President Barack Obama’s signature legislative initiative, the Affordable Care Act.

Clinton said, “There are things we can do to improve (the Affordable Care Act), but to tear it up and start over again, pushing our country back into that kind of a contentious debate, I think is the wrong direction.”

Sanders countered, “We’re not going to tear up the Affordable Care Act. I helped write it.”

We decided to check whether Sanders has a solid claim to have “helped write” the Affordable Care Act.

As our friends at the Washington Post Fact Checker have noted, Sanders pushed hard for a more liberal version of health care reform -- the American Health Security Act of 2009, which would have implemented a national single-payer system. (Under a single-payer system, the government, rather than private health insurers, pays all medical bills, along the lines of Medicare.)

Sanders backed down after Sen. Tom Coburn, R-Okla., used a procedural move to force a full reading of Sanders’ bill, a move that would have taken hours of floor time and imperiled passage of a more moderate bill backed by Obama and his allies.

However, as negotiations were in their final stage, Sanders successfully pushed for the inclusion of $11 billion in funding for community health centers, especially in rural areas. The insertion of this funding helped bring together both Democratic lawmakers on the left and Democrats representing more conservative, rural areas.

“There was no one who played a more important role than Sen. Sanders” in securing that funding, Daniel Hawkins, vice president of the National Association of Community Health Centers, told the Intercept last year.

So there’s a good case to be made that Sanders made an important contribution to the final legislation.

Still, when Sanders says he “helped write” the bill, it would be reasonable to imagine that Sanders was an integral player in the crafting of the bill over a long period of time -- an insider in the process. And that’s not the reality.

Before the final bill was enacted, Sanders and his allies on the party’s left flank regularly expressed frustration at the concessions they had to make during the legislative process.

“Public-option proponents, including Sanders and Sen. Sherrod Brown, D-Ohio, say they already have given up enough,” Politico reported in late November 2009. “They agreed to forgo a single-payer system. They decided not to push a government plan tied to Medicare rates. And they accepted (Harry) Reid's proposal to include the opt-out provision. That's it, they say.”

Politico went on to quote Sanders saying, “I have made it clear to the administration and Democratic leadership that my vote for the final bill is by no means guaranteed."

A few weeks later, Washington Post columnist Dana Milbank reported that Sanders was still undecided on supporting the primary Democratic bill. "I am talking to the Democratic leadership, trying my best to salvage some positive things in this bill, so I am not on board yet."

And on Dec. 18, the New York Times quoted Sanders saying, ''I don't sleep well. I am struggling with this issue very hard, trying to sort out what is positive in this bill, what is negative in the bill, what it means for our country if there is no health insurance legislation, when we will come back to it. … And I have to combine that with the fact that I absolutely know that the insurance companies and the drug companies will be laughing all the way to the bank the day after this is passed.''

Sanders eventually supported the legislation.

Our ruling: Sanders said he “helped write” the Affordable Care Act. He deserves credit for one provision of it -- worth a not-insignificant $11 billion. But overall, he was hardly an inside crafter of the bill. Until his effort was blocked by a GOP procedural move, Sanders supported a more aggressive single-payer system, and multiple news articles quoted him as being undecided about supporting the main Democratic bill until late in the process.

Sanders’ statement contains an element of truth but ignores critical facts that would give a different impression. That meets our definition of Mostly False.

In the increasingly competitive Democratic primary for president, former Secretary of State Hillary Clinton has spent months hammering Vermont Sen. Bernie Sanders for his vote on a 2005 bill that provided gun makers, sellers and trade associations with significant protection against lawsuits.

Now, after Sanders clarified his position on the issue, she’s calling him a flip-flopper.

Sanders, who represents the small, rural state of Vermont where guns are widely accepted, has sometimes sided with advocates of gun rights on key legislation and sometimes sided with supporters of gun control. One of the primary examples where Sanders broke with Democrats is in supporting the gun liability bill, which was enacted in 2005. A similar bill also passed the U.S. House in 2003. Sanders, then serving in the House, voted for it both times.

Clinton called on Sanders to "stand up and say I got this one wrong" in a Jan. 8 interview on MSNBC’s Hardball.

About a week later, Sanders released a statement on the gun-liability issue in the run-up to the Jan. 17 Democratic debate in Charleston, S.C. In a news release, Sanders said, "I’m pleased that this legislation is being introduced," referring to proposals by Sen. Richard Blumenthal, D-Conn., and Rep. Adam Schiff, D-Calif., to rescind portions of the 2005 law.

"As I have said for many months now, we need to look at the underlying law and tighten it up," Sanders added.

The Clinton camp portrayed this as a flip-flop during the Charleston debate. Clinton said, "I am pleased to hear that Sen. Sanders has reversed his position on immunity, and I look forward to him joining with those members of Congress who have already introduced legislation."

The Sanders camp disagreed that this was a change of position. Sanders campaign manager Jeff Weaver had told MSNBC, "This is not a flip flop, this is consistent with the position he held earlier in the campaign."

So is Clinton’s portrayal accurate? We took a closer look.

Sanders’ vote on the 2005 bill

While the bill includes two relatively non-controversial provisions -- one on trigger locks and the other on armor-piercing bullets -- the most contentious elements of the 2005 bill, and the ones that drove overwhelming Democratic opposition at the time, deal with liability for gun makers and sellers.

The official bill summary provides for broad-based immunity for gun sellers, but it also provides a few exceptions, such as:

• Cases where a person transfers a firearm knowing that a violent crime or drug-trafficking crime will be committed with it;

• Cases where a seller is negligent or a manufacturer or seller knowingly violated the law;

• And cases involving an injury caused by a physical defect with the weapon when it was used as intended.

What Sanders and his campaign said prior to Jan. 16

On numerous occasions, Sanders or his aides have expressed comfort with his past vote.

In June 2015, Weaver, Sanders’ campaign manager, told Politico, "I believe he would make the same vote" today.

In October, at a Democratic debate in Las Vegas, Sanders said, "If somebody has a gun and it falls into the hands of a murderer and that murderer kills somebody with the gun, do you hold the gun manufacturer responsible? Not any more than you would hold a hammer company responsible if somebody beats somebody over the head with a hammer. That is not what a lawsuit should be about."

Sanders continued to make similar arguments into January 2016. Asked by CBS whether gun manufacturers should be held accountable for gun deaths, Sanders said, "Of course not, that doesn't make any sense," he said, while adding that if guns fall into the hands of criminals, "Of course you hold the gun manufacturers liable."

At the same time, Sanders has increasingly fine-tuned his stance, saying he’d be open to reconsidering his vote on the 2005 measure.

In an October 2015 interview on NBC’s Meet the Press, Sanders said he was "willing to see changes" in the gun-liability provision: "Can we take another look at that liability issue? Yes."

Then, in January, a few days before the campaign issued its news release on gun liability, Sanders told a crowd in Iowa, "I think we should take another look at that legislation and get rid of those provisions which allow gun manufacturers to act irresponsibly."

The Jan. 16 news release

In the news release, Sanders expressed support for the Blumenthal-Schiff initiative to rescind the liability portions of the 2005 law. The trigger-lock and armor-piercing-ammunition provisions would not be overturned. The sponsors said they will try to advance the Equal Access to Justice for Victims of Gun Violence Act as an amendment to an appropriations bill, according to the New York Times.

On the Jan. 17 edition of NBC’s Meet the Press, Sanders explained that in 2005, "there were things in (the bill) that I did not like and I was willing to rethink. We have rethought it. There's a bill apparently being introduced, I like that bill, it makes some good changes and we will be supportive of it."

Sanders did say in his news release that he will be proposing an amendment to the Blumenthal and Schiff bills to require the Commerce Department to monitor and report on the law’s impact in rural areas on the availability of hunting supplies, including firearms, sold by non-negligent local gun stores. This, he indicated, was consistent with his past concerns about the threat of lawsuits against small gun shops serving primarily rural areas of Vermont.

Our ruling: So is Clinton right that Sanders flip-flopped on immunity for gun manufacturers and sellers?

Sanders voted for the 2005 measure that provided broad liability exclusions for gunmakers and sellers.

After months of Sanders and his staff defending the vote, Sanders’ position started to evolve in October. Sanders’ position three months ago -- that he would "take another look" at the liability question -- is consistent with his Jan. 16 news release saying he supported a proposal to rescind the immunity provisions. But to look back only to October doesn’t tell the full story, ignoring not only the 2003 and 2005 votes but also several instances in which Sanders or his staff defended those votes in interviews between June 2015 and early January 2016.

That sounds like a flip-flop to us, so we rate Clinton’s statement True.

Trying to highlight an area where she is to the left of her opponent, Hillary Clinton attacked Bernie Sanders for his position on guns during the NBC-YouTube Democratic debate in Charleston, S.C.

Guns are a particularly emotional topic in South Carolina after Dylann Roof was accused of killing nine African-Americans in a Charleston church in June.

Sanders, a senator from Vermont, defended his record on guns saying that he "supported from day one an instant background check to make certain that people who should have guns do not have guns."

Clinton fired back at Sanders with a list of his votes on gun bills, including this one:

"He voted for what we call the ‘Charleston loophole.’ "

We wanted to know what Clinton meant by the "Charleston loophole" and if Sanders voted for it.

Brady bill

Clinton and some advocates for tighter gun laws argued Roof was abetted by the three-day time limit for background checks for gun purchases, dubbing it the "Charleston loophole." Supporters of gun rights say blame actually goes to the FBI and its botched paperwork.

Under current federal law, the FBI performs background checks on would-be gun buyers in South Carolina and 29 other states through its National Instant Criminal Background Check System. (The rest of the states do their own background checks.) If the check isn’t denied or completed in three days, the gun seller can proceed with the sale.

Roof was able to get a gun as a result of clerical errors.

Roof tried to buy a handgun in West Columbia, S.C., on April 11. An FBI examiner found that Roof had been arrested for a drug charge March 1. Because the records didn’t show a conviction, the examiner couldn’t deny the purchase but continued to look into Roof’s criminal history.

Roof’s rap sheet mistakenly listed the neighboring county’s sheriff office as the agency that arrested him, leading the FBI examiner to request more information from the wrong offices.

When the three days were up, the case was still listed as "pending" and Roof was able to purchase the gun. Two months later, Roof allegedly shot and killed nine worshippers and injured one in a historically black church in Charleston. He faces trial on murder charges later this year.

The waiting period was at the heart of the the Brady Handgun Violence Prevention Act, which passed in 1993.

Sanders, then in the U.S. House of Representatives, voted against the Brady Bill five times -- including a version that reinstated a five-day waiting period. In November 1993, Sanders voted for an amendment imposing an instant background check instead. The problem was technology for instant checks didn’t exist at the time.

As a result, according to the Washington Post Fact-Checker, supporters of the Brady bill were forced to negotiate a compromise on a waiting period. What first was proposed as 10 days ultimately was whittled to three days.

The final compromise version of the Brady bill was passed and signed into law on Nov. 30, 1993. It prohibited the transfer of a gun to an unlicensed individual, unless three business days have lapsed and the system has not notified the transferor that it would violate the law.

Sanders voted against the final bill.

Sanders’ campaign manager Jeff Weaver told us in July that Sanders voted against the bill because he believed a national waiting period was a federal overreach and because he was answering to his constituents. (We did not get a response from the Sanders’ campaign on debate night about Clinton’s attack.)

So to recap: Sanders didn’t vote for a "Charleston Loophole" specifically, but he did support shortening the waiting period. Whether extra time would have kept Roof from purchasing a gun is unclear.

Our ruling: Clinton said that Sanders "voted for what we call the Charleston loophole."

His votes were actually against federally mandated waiting periods, not for a provision that sets a time limit on a background check.

In 2015, Roof was able to buy a gun after the waiting period had lapsed -- the result of a clerical error when the FBI sought records from the wrong local law enforcement agency about Roof. Whether more time would have made a difference remains unknown. But Roof was able to purchase the gun after a three-day waiting period expired.

Sanders’ votes don’t line up precisely as Clinton presented them. Sanders was against waiting periods for background checks. Roof was able to purchase a gun after waiting out a three-day time limit on background checks. We rate this claim Mostly True.

FACT CHECK #4: Hillary Clinton - "We now have driven (health care) costs down to the lowest they've been in 50 years."

During the Jan. 17 Democratic presidential debate, Hillary Clinton argued against, as she put it, doing away with Obamacare and trying to replace it with the type of single-payer system her primary opponent, Bernie Sanders, wants to implement.

Attempts to do that when Democrats controlled the government failed, she noted, arguing that Obamacare has accomplished a lot.

"We have the Affordable Care Act. Let's make it work," Clinton said. "We now have driven costs down to the lowest they've been in 50 years. Now we've got to get individual costs down. That's what I'm planning to do."

Health care costs are the lowest in 50 years? That's probably news to consumers who keep seeing their premiums and copays going up.

We decided to check the vital signs of this claim.

We found that Clinton was incorrect. The actual per-person cost of health care has increased steadily over the last half-century, according to a 2013 White House report.

When we contacted the Clinton campaign, spokesman Nick Merrill said what Clinton was actually talking about was the rate at which health care costs have been going up.

"Health care price inflation is at its lowest rate in 50 years," he said in an email, adding that it is "currently running at just 1 percent on a year-over-year basis, the lowest level since January 1962."

He cited the same White House report from November 2013 to support that assertion.

PolitiFact has touched on this issue before.

During a 2012 president debate, President Barack Obama said that because of Obamacare, "over the last two years, health care premiums have gone up -- it's true -- but they've gone up slower than any time in the last 50 years."

We found that Obama's point about premiums was wrong, and gave him a False.

But we did find, more to the point that Clinton's campaign says Clinton was trying to make, that health care spending at the time had grown slower than at any time in the previous 50 years. Those data come from 2009 and 2010, and preliminary estimates from 2011 were showing a similar trend.

However, that may not be true anymore.

More recent data from the Office of the Actuary of the Centers for Medicare and Medicaid Services, published in July 2015, also showed a recent increase, although the office appears to calculate its statistics differently.

It reports that the per-person annual growth of all national health expenditures went from 3.3 percent in 2012, bottomed out at 2.9 percent in 2013, and were projected to grow to 4.7 percent in 2014.

Because of the increases, according to the report, "the health spending share of the economy is projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024."

Our ruling: Clinton said during the debate, "We now have driven costs down to the lowest they've been in 50 years."

Although the rate of growth has been at historic lows, the actual per-person cost of health care has increased steadily over the last half century. Only the rate of decline has slowed, a very different measure. The Clinton campaign acknowledges that the candidate misspoke.